A comparative study of knowledge and attitudes regarding biomedical waste (BMW) management with a preliminary intervention in an academic hospital Aims: 1) To assess and compare the knowledge and attitudes regarding biomedical waste (BMW) management in specialists, resident doctors, new medical interns, and fi nal year nursing students. 2) To assess the effectiveness of a training program in changing the knowledge and attitudes regarding BMW management. and Z tests applied. Results: There was a statistically signifi cant difference in the knowledge scores between the groups as determined by a one-way ANOVA test (F (3,226) = 11.098, P < 0.001). A Tukey's post hoc test revealed that the specialists (20.82 ± 5.121) knowledge scores were signifi cantly higher as compared to resident doctors (16.96 ± 5.268), medical interns (18.44 ± 4.293), and nursing group (15.33 ± 5.144). The positive attitude towards safe management of BMW was not found to be signifi cant. After the training program in the medical interns' a statistically signifi cant increase in their knowledge on BMW management was seen. Conclusion: The knowledge and attitudes between the groups of healthcare personnel varied and was not found to be satisfactory. Training programs with periodical sensitization sessions on BMW management are recommended, especially focusing at the junior level.Key words: Att itudes, assessment, biomedical waste, biomedical waste management, educational intervention, knowledge, training Original Article INTRODUCTIONHealthcare activities like immunization, diagnostic tests, medical treatments, and laboratory examinations protect and restore health and save lives. At the same time, however, health services may generate large quantity of wastes and by-products that need to be handled safely and disposed of properly. Public concern about medical waste dates back to early 1980's when large quantities of syringes and needles were found on the beaches of the East Coast and in Florida, USA. In India, the concern for medical waste has come to the fore in recent years. The Government of India notifi ed the Biomedical Waste (Management and Handling) Rules in July 1998. "Biomedical waste" (BMW) means any waste, which is generated during the diagnosis, treatment, or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals, and including categories mentioned in Schedule I. [1,2] In India, studies have estimated the average hospital waste generation rate ranges between 0.5 and 2.0 kg/bed/day and annually about 0.33 million tons of waste are generated.[3] Healthcare workers have an important opportunity to manage the environmental effects of their practices. Their efforts may seem small, but each step builds a base of sound behaviors and thinking that are necessary for the success AbstractAccess this article online Website: www.ijmedph.org

Background:Human immunodeficiency virus (HIV) disclosure offers important benefits to people living with HIV/AIDS. However, fear of discrimination, blame, and disruption of family relationships can make disclosure a difficult decision. Barriers to HIV disclosure are influenced by the particular culture within which the individuals live. Although many studies have assessed such barriers in the U.S., very few studies have explored the factors that facilitate or prevent HIV disclosure in India. Understanding these factors is critical to the refinement, development, and implementation of a counseling intervention to facilitate disclosure.Materials and Methods:To explore these factors, we conducted 30 in-depth interviews in the local language with HIV- positive individuals from the Integrated Counselling and Testing Centre in Gujarat, India, assessing the experiences, perceived barriers, and facilitators to disclosure. To triangulate the findings, we conducted two focus group discussions with HIV medical and non-medical service providers, respectively.Results:Perceived HIV-associated stigma, fear of discrimination, and fear of family breakdown acted as barriers to HIV disclosure. Most people living with HIV/AIDS came to know of their HIV status due to poor physical health, spousal HIV-positive status, or a positive HIV test during pregnancy. Some wives only learned of their husbands’ HIV positive status after their husbands died. The focus group participants confirmed similar findings. Disclosure had serious implications for individuals living with HIV, such as divorce, maltreatment, ostracism, and decisions regarding child bearing.Interpretation and Conclusion:The identified barriers and facilitators in the present study can be used to augment training of HIV service providers working in voluntary counseling and testing centers in India.

The COVID-19 pandemic had led to an increase surge of mucormycosis in COVID-19 patients, especially in India. Diabetes and irrational usage of corticosteroid to treat COVID-19 were some of the factors implicated for COVID-19 associated mucormycosis (CAM). We designed this case control study to identify risk factors for mucormycosis in COVID-19 patients. The study was conducted at a private tertiary care center in western India. Data was extracted from records of COVID 19 patients (Jan to May 2021) and divided into two groups: Those with proven or probable mucormycosis, and those without mucormycosis with a ratio of 1:3. A binary logistic regression analysis was done to assess potential risk factors for CAM. A total of 64 CAM and 205 controls were included in the analysis. Age and sex distribution were similar in cases and controls with the majority of males in both the groups (69.9%) and the mean age was 56.4 (±13.5) years. We compared the comorbidities and treatment received during acute COVID-19, specifically the place of admission, pharmacotherapy (steroids, tocilizumab, remdesivir), and requirement of oxygen as a risk factor for CAM. In a multivariate analysis, risk factors associated with increased odds of CAM were new-onset diabetes (v/s non-diabetics, adjusted OR 48.66, 95% CI 14.3-166), pre-existing diabetes (v/s Non-Diabetics, aOR 2.93, 95% CI 1.4-6.1), corticosteroid therapy (aOR 3.64, 95% CI 1.2-10.9) and home isolation (v/s Ward admission, aOR 4.8, 95% CI 2-11.3). Diabetes, especially new onset, along with corticosteroid usage and home isolation were the predominant risk factors for CAM.